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Transient quadriparesis with drop attack and chronic neck and arm pain
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| Recumbent MRI |
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Upright MRI |
This 40 years old lady has been suffering for years from neck pain. A prior recumbent MRI had shown a C5C6 disc degeneration with posterior bulge and moderate segmental kyphosis.
Due to progressive worsening despite repeated conservative treatment modalities and the occurrence of drop attacks during forward bending, with transient paresthesias and loss of tone in the legs, a new fmri was performed.
Upright MRI showed an increasing disc protrusion and segmental kyphosis at the C5C6 level (thick arrow), but also a descensus of the cerebellar tonsils behind the arch of C1 (thin arrow), with brainstem compression against the odontoid process (double arrow). This Chiari I Malformation with position-related downward herniation through the foramen magnum explains the drop attacks with loss of tone in the legs.
In front of this double pathology, the right treatment priorities could be set: Posterior fossa decompression with C1 laminectomy and dural plasty. In case of later increasing C6 symptoms, anterior C5C6 discectomy with cage placement could be performed. A further conservative treatment may not be successful, if an obvious mechanical pathology can be disclosed by functional spinal MRI.
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Gruppenstudien